Parenting Style Impacts Type 1 Diabetes Control in Children, Adolescents
Parenting style can play an important role in improving glycemic control in children and adolescents with type 1 diabetes, according to a study published in the August issue of Diabetes Care and its accompanying editorial.
Researchers at the Israel Diabetes Center of Schneider Children’s Medical Center of Israel found an association between fathers who parent authoritatively and improved glycemic control in their children, while a sense of helplessness in both fathers and mothers was associated with worse glycemic control and worse adherence to treatment among their children.
The study included parents and children/adolescents ages 11-18 years who had been living with type 1 diabetes for at least a year. Researchers examined the children’s glycemic control (based on their A1C values); their adherence to their diabetes treatment plan; their parents’ parenting styles and sense of helplessness; and demographic information. The parenting styles were classified as authoritative (characterized by setting clear limits to the child in a non-coercive manner), permissive (few efforts by the parents to direct and limit their child’s behavior), and authoritarian (coercive, harsh and punitive).
Higher authoritativeness of fathers, but not mothers, was associated with better treatment adherence and improved glycemic control in the children, the researchers found. Among mothers, a higher level of permissiveness was associated with poorer treatment adherence. Authoritarian parenting styles were not associated with either glycemic control or treatment adherence, but when the analysis was limited to boys, a higher level of maternal authoritarianism was associated with poorer treatment adherence. Finally, a higher sense of helplessness in both fathers and mothers was associated with worse glycemic control and worse adherence to treatment in the children.
“The findings may help health care providers and parents in determining appropriate parental involvement in the daily management of children and adolescents’ diabetes needs,” said lead researcher Joseph Meyerovitch, MD, of the Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel.
“The association between paternal level of authoritativeness and diabetes control measures highlights the importance of fathers’ involvement in children’s diabetes management. Unfortunately, our clinical experience along with empirical evidence suggests that when compared with mothers, fathers tend to take a too-small role in their child’s diabetes management. We believe fathers should be encouraged and educated to be more engaged in their child’s routine diabetes care, specifically by adopting a more authoritative stance,” Meyerovitch said.
In an accompanying editorial, Barbara Anderson, PhD, Professor of Pediatrics, Baylor College of Medicine, notes that previous studies have shown that authoritative parenting styles (specifically having high expectations for child self-control) are also associated with having a lower prevalence of overweight children; conversely, research has shown that children of permissive mothers were twice as likely to be overweight when compared with those of authoritative mothers.
“In other words, we should not overlook the critical role that a parent plays in creating a home environment and expectations that can seriously impact a child’s health,” Anderson said.
Taken together, this research, she concluded in her editorial, “implies that for optimal family management of type 1 and type 2 diabetes, as well as for prevention of overweight and type 2 diabetes in youth, clinicians must be trained to assist parents of all cultural backgrounds to strive for an authoritative parenting style with respect to management of diabetes and feeding, while remaining sensitive to other stressors impacting the parents and family.”
The American Diabetes Association recognizes the challenges of raising children with diabetes and has published a book designed specifically to help parents deal with these additional complexities. The third edition of American Diabetes Association’s Guide to Raising a Child with Diabetes, by Jean Betschart Roemer, MN, MSN, CRNP, CDE, features the latest advances in diabetes care and parenting advice from diabetes experts. Full of problem-solving examples and easy-to-use tables, this book shows parents how to adjust insulin to allow for foods children like to eat; how to care for a child with diabetes; manage sick days; and plan nutritious and balanced meals. The guide also addresses the emotional side of raising a child with diabetes, such as how to help your child maintain a busy schedule and still feel healthy and strong, negotiate the twists and turns of being "different," and accept both the physical and emotional challenges that life with diabetes includes.
Roemer is a pediatric nurse practitioner and certified diabetes educator in the Department of Endocrinology, Diabetes and Metabolism, at Children's Hospital of Pittsburgh. She has written extensively for health care professionals, parents, children, and teens, and has worked with children with diabetes and their families since 1980. Roemer, mother of three, and grandmother of three, was diagnosed with type 1 diabetes in 1968.
The Guide to Raising a Child with Diabetes, 3rd edition, is available at www.ShopDiabetes.org, at bookstores nationwide, or by calling 1-800-232-6733.
The American Diabetes Association is leading the fight to Stop Diabetes and its deadly consequences and fighting for those affected by diabetes. The Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes. Founded in 1940, our mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. For more information please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit www.diabetes.org. Information from both these sources is available in English and Spanish.